UNIVERSITY OF BRADFORD
HEALTH & SAFETY SERVICES
REGISTRATION FOR WORK WITH
RADIOACTIVE SUBSTANCES – UNSEALED SOURCES
All staff and students (except those carrying out undergraduate practical’s under close staff supervision) are
required to register with Health & Safety Services BEFORE starting work with any source of x-radiation.
A registration form must be completed for each new project or for significant changes to a previously submitted
scheme of work.
Please complete the form as a Word document, keeping to the spaces provided. If you need more space add
additional sheets as necessary. Then print a copy and sign the form before giving it to your Department Radiation
Protection Supervisor.
It would be advantageous to complete this form with the help of your Department Radiation Protection Supervisor.
PERSONAL DETAILS
Name:
Date of birth:
Sex: M / F
NB – if you are pregnant or likely to become pregnant during the work with ionising radiation, please
consult the University’s Senior Medical Officer before completing this form
Status:
Undergraduate / Postgraduate / Research Associate / Technician / Lecturer / Other (please give details)
Department:
Academic Supervisor:
EXTERNAL ATTACHMENT
Please give details of any work to be done outside the University premises:
PREVIOUS WORK WITH IONISING RADIATIONS
Please provide details of any work with ionising radiations before coming to the University, including
names and addresses of contact points for previous radiation dose records:
MEDICAL EXPOSURES
Please give details of any medical exposures to ionising radiations (all x-rays excluding dental
exposures, plus any nuclear medicine investigations)
TRAINING
Please give details of any previous training in radiation protection
NB – The Safety & Radiation Protection Office runs a basic radiation protection course near the start
of each term. You are required to attend the first available course before you start work with ionising
radiation unless you hear otherwise.
PROPOSED SCHEME OF WORK (RADIOACTIVE SUBSTANCES – UNSEALED SOURCES)
Radionuclide(s):
Activity (MBq): Stock
Working Solution
Each Experimental Run
Chemical Form:
Expected metabolic pathway if
ingested:
Where will the radioactive
material be obtained from:
(eg Company name / other
University):
Physical Form:
Stock
Experimental Work
Location of Work:
Stock
Experimental Work
Approximate Frequency of Use:
Stock Handling
Experimental Work
Expected Waste:
Solid – form, volume, activity
Liquid – volume, activity
How will any waste be dealt
with?:
Purpose of work to be
undertaken:
Basic Description of Work
(including any need for external
protective equipment):
Potential Accident Scenario(s)
and Contingency Plan(s)
STUDENT/RESEARCHER SIGNATURE
Signed:
Date:
ACADEMIC SUPERVISOR APPROVAL
Name:
Date:
Signed:
Comments:
RADIATION PROTECTION SUPERVISOR SIGNATURE
Name:
Date:
Signed:
Comments:
HEALTH & SAFETY SERVICES / RADIATION PROTECTION ADVISER SIGNATURE
Name:
Signed:
Comments:
Date: